Ablation device with jaws

ABSTRACT

System, device and method for ablating target tissue adjacent pulmonary veins of a patient through an incision. An ablation device can include a hinge including a cam assembly, a moving arm, a floating jaw, and a lower jaw. Fingers can engage the floating jaw to hold the floating jaw in a first position with respect to the moving arm. Some embodiments of the invention can provide an ablation device including a central support, an upper four-bar linkage coupled to the central support, an upper jaw coupled to the upper linkage, a lower four-bar linkage coupled to the central support, and a lower jaw coupled to the lower linkage. Some embodiments of the invention can provide an ablation device having an upper jaw including a first cannula connection and a lower jaw including a second cannula connection. The system can include a first catheter coupled to the first cannula connection and a second catheter coupled to the second cannula connection. The first and second catheters can be inserted through the incision and can move the upper and lower jaws adjacent the pulmonary veins.

RELATED APPLICATIONS

The present non-provisional patent application is a divisional of U.S.patent application Ser. No. 12/499,356, filed Jul. 8, 2009, whichapplication is a divisional of U.S. patent application Ser. No.11/142,954, filed Jun. 2, 2005, now issued U.S. Pat. No. 7,566,334,which application claims priority under 35 USC 119(e) from commonlyowned provisional U.S. patent application having Ser. No. 60/576,096filed on Jun. 2, 2004, which is incorporated herein by reference in itsentirety and titled “Ablation clamp with self adjusting jaws”, theentire contents of which is incorporated herein by reference in itsentirety.

This application also claims the benefit of the filing date of U.S.Provisional Patent Application No. 60/581,139 filed on Jun. 18, 2004,which is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

The invention is generally directed to ablating cardiac tissue with aminimally-invasive procedure.

BACKGROUND

The interest in ablation practice has been to use minimally-invasivetechniques to ease patient recovery. Bipolar ablation devices have beenused extensively to deliver linear lesions accurately to tissueespecially for the purpose of reducing the effect of atrialfibrillations.

SUMMARY OF THE INVENTION

Some embodiments of the invention provide an ablation device forablating target tissue adjacent pulmonary veins of a patient. Theablation device can include a hinge including a cam assembly, and thecam assembly can include one or more riders and one or more fingers. Theablation device can include a moving arm coupled to the hinge. Themoving arm can include a cam surface that engages the riders. A floatingjaw can be coupled to the moving arm. The fingers can engage thefloating jaw to hold the floating jaw in a first position with respectto the moving arm. The floating jaw can include a first electrode thatreceives ablation energy. A lower jaw can be coupled to the hinge. Thelower jaw can include a channel that receives the fingers. The channelcan allow the floating jaw to move to a second position with respect tothe moving arm. The lower jaw can include a second electrode thatreceives ablation energy.

Embodiments of the invention can provide an ablation device including acentral support, an upper four-bar linkage coupled to the centralsupport, and an upper jaw coupled to the upper linkage. The upper jawcan include an upper electrode that can receive ablation energy. Theablation device can also include a lower four-bar linkage coupled to thecentral support and a lower jaw coupled to the lower linkage. The lowerjaw can include a lower electrode that can receive ablation energy.

One embodiment of a method of the invention can include providing anablation device with one or more floating jaws including one or moreelectrodes, locking the floating jaws, and inserting the floating jawsinto a side of the patient. The method can also include approaching thepulmonary veins substantially directly from the side of the patient withthe floating jaws. The method can further include unlocking the floatingjaws, articulating the floating jaws with respect to a central supportto accommodate target tissue adjacent the pulmonary veins, and providingablation energy to the electrodes.

One embodiment of the invention can provide an ablation system forablating target tissue adjacent pulmonary veins of a patient through anincision in the patient. The ablation system can include an ablationtool having a handle, an upper jaw, a lower jaw, and a hingedconnection. The upper jaw can include a first cannula connection, andthe lower jaw can include a second cannula connection. One or moreelectrodes can be coupled to the upper jaw and/or the lower jaw. Theelectrode can receive ablation energy. The ablation system can alsoinclude a first catheter coupled to the first cannula connection. Thefirst catheter can be inserted through the incision and can move theupper jaw adjacent the pulmonary veins. The second catheter can becoupled to the second cannula connection. The second catheter can beinserted through the incision and can move the lower jaw adjacent thepulmonary veins.

One embodiment of a method of the invention can include inserting afirst catheter through an incision and positioning the first catheter ona first side of the pulmonary veins, and inserting a second catheterthrough the incision and positioning the second catheter on a secondside of the pulmonary veins. The method can also include coupling anupper jaw of an ablation tool to the first catheter, and coupling alower jaw of the ablation tool to the second catheter. The method canfurther include moving the upper jaw adjacent the pulmonary veins withthe first catheter, and moving the lower jaw adjacent the pulmonaryveins with the second catheter. The method can still further includeproviding ablation energy to one or more electrodes coupled to the upperjaw and/or the lower jaw.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a cross-sectional view of a patient's heart and a schematicview of an ablation device according to one embodiment of the invention.

FIGS. 2A-2F are perspective views of an ablation device according to oneembodiment of the invention.

FIGS. 3A-3E are side and schematic views of an ablation device accordingto one embodiment of the invention.

FIGS. 4A-4E are side and perspective views of an ablation deviceaccording to one embodiment of the invention.

FIGS. 5A-5D are side and perspective views of an ablation deviceaccording to one embodiment of the invention.

FIGS. 6A-6B are side and schematic views of an ablation device accordingto one embodiment of the invention.

FIGS. 7A-7I are side and schematic views of an ablation device accordingto one embodiment of the invention.

FIGS. 8A-8E are side and schematic views of an ablation device accordingto one embodiment of the invention.

FIG. 9 is a perspective view of an ablation device according to oneembodiment of the invention.

FIG. 10 is a perspective view of a distal end of the ablation device ofFIG. 9.

FIG. 11 is a cross-sectional view of a patient's heart with the ablationdevice of FIG. 9 in a closed position and coupled to catheters insertednear pulmonary veins.

FIG. 12 is a cross-sectional view of a patient's heart with the ablationdevice of FIG. 1 in an open position and coupled to catheters insertednear pulmonary veins.

FIG. 13 is a schematic illustration of two ablation devices insertedadjacent pulmonary veins in a patient's heart.

FIG. 14 is another schematic illustration of two ablation devicesinserted adjacent pulmonary veins in a patient's heart.

DETAILED DESCRIPTION

Before any embodiments of the invention are explained in detail, it isto be understood that the invention is not limited in its application tothe details of construction and the arrangement of components set forthin the following description or illustrated in the following drawings.The invention is capable of other embodiments and of being practiced orof being carried out in various ways. Also, it is to be understood thatthe phraseology and terminology used herein is for the purpose ofdescription and should not be regarded as limited. The use of“including,” “comprising” or “having” and variations thereof herein ismeant to encompass the items listed thereafter and equivalents thereofas well as additional items. The terms “mounted,” “connected” and“coupled” are used broadly and encompass both direct and indirectmounting, connecting and coupling. Further, “connected” and “coupled”are not restricted to physical or mechanical connections or couplings,and can include electrical connections or couplings, whether direct orindirect.

Some embodiments of a method of the invention provide the insertion ofan ablation device having one or more electrodes on opposing jaws forclamping cardiac tissue. The electrodes can be energized with radiofrequency or other energy to cause cell destruction. Some embodiments ofthe ablation device include jaws that can be held in place with respectto support arms, while the jaws are placed in predetermined locationsalong the tissue to be ablated. As the jaws are brought together, thejaws can be released from their retention position and can be allowed tofloat with respect to pivot points on a clamp frame in order to securelybear against and ablate the target tissue with the electrodes carried bythe jaws. In one embodiment, links coupled to the jaws are spring biasedto allow the jaws to move when an overriding force exerted from theclamping force overcomes the spring force.

Some embodiments of the ablation device can include a clamp-type jawclosure, including a jaw with some limited “float” to accommodatevarying tissue thickness. When the jaws are fully opened, the floatingjaw can be locked to prevent relative movement that could impedeinsertion of the ablation device into the patient's cavity. As the jawsare closed, the floating jaw can be allowed more and more relativemovement to accommodate the target tissue. In some embodiments, the jawscan articulate left and right with inputs from a handle to allowadditional adjustment relative to the target tissue. These additionaladjustments can require bilateral access. However, the bilateral accesscan be achieved through ports, eliminating the need for a thoracotomy.

In one embodiment, the ablation device can include a hinge having a camsurface and one or more riders. In some embodiments, the riders can becoupled to a fixed jaw and the cam surface can be coupled to a floatingjaw. In one embodiment, the cam surface can be coupled to a moving armcoupled to the floating jaw. When the jaws are separated by an anglelarger than a predefined acute angle, the floating jaw can be maintainedin an unyielding angular relation to the fixed jaw. As the angle betweenthe jaws approaches the predefined acute angle, the riders and the camsurface can separate to allow the floating jaw to move with respect tothe fixed jaw. The floating jaw can then bear against the target tissueat the most advantageous angle to provide maximum contact between theelectrodes on the jaws and the target tissue.

Some embodiments of the ablation device can be used to approach the leftpulmonary veins from a port on the left side of the patient and theright pulmonary veins from a port on the right side of the patient.Rather than approaching the pulmonary veins from an inferior or superiorpoint as in an open chest procedure, some embodiments of the ablationdevice can be used to approach the pulmonary veins directly from theside.

In some embodiments, the ablation device can include two jaws that canbe inserted into the patient separately and then assembled in place.This provides a simple process for insertion of the ablation device,because the surgeon can concentrate on one jaw at a time. The first jawcan be inserted from a right thoracotomy through a previously-dissectedpericardial reflection under the superior vena cava into the transversesinus until the first jaw is hooked around the left pulmonary veins intothe oblique sinus. The second jaw can be inserted through the rightthoracotomy below the inferior vena cava through thepreviously-dissected pericardial reflection and then attached to thefirst jaw to form a complete ablation device. Ablation can be performedin two steps. Using independent jaw closure mechanisms, the first jawcan be closed and actuated. Once the first jaw is open, the second jawcan be closed and actuated. In this manner, only half of the pulmonaryveins are occluded at any given time.

Some embodiments of the invention can be used to clamp cardiac tissueand carry electrodes used to deliver radio frequency energy during anablation procedure. Embodiments of the ablation device can include alinkage that can provide a spring-biased movement of clamping members.Clamping can start at a distal end and move progressively toward aproximal end of the clamping members. Some embodiments of the inventioncan provide a minimal envelope size relative to the clamping capacity.Some embodiments of the invention can be used for effectors of anablation device. Embodiments of the invention can also be used for otherapplications requiring tissue clamping or manipulation. Embodiments ofthe ablation device can include a distal end for use inminimally-invasive cardiac surgery or in conventional cardiac surgery.For the minimally-invasive cardiac surgeries, the ablation device caninclude dual floating jaws. For conventional cardiac surgeries, theablation device can include a single floating jaw and one fixed jaw.Some embodiments of the invention can include an ablation device that isspring biased or elastically biased for parallel jaw action. Embodimentsof the ablation device can have a minimal size relative to the clampingcapacity. Some embodiments of the ablation device provide distal toproximal progressive clamping action. Some embodiments of the ablationdevice can include an increased gap at a vertex of a proximal end of ajaw assembly.

FIG. 1 is a schematic illustration of two ablation devices 100positioned within a patient's heart around pulmonary veins 13. Each oneof the ablation devices 100 can include a hinge 10, a lower jaw 14, anda floating jaw 20. One ablation device 100 can be inserted into thepatient's heart from a port on the patient's left side, and anotherablation device 100 can be inserted into the patient's heart from a porton the patient's right side. In some embodiments, one or more ablationdevices 100 can be used to access the pulmonary veins 13 from the sidesof the patient through ports, which can eliminate the need for athoracotomy. In other embodiments, one or more ablation devices 100 canbe used in combination with a thoracotomy.

As shown in FIGS. 2A-2F, a drawbridge concept can incorporate abilateral bipolar clamp into an ablation device 100 that can be used fora single-sided approach. The ablation device 100 can be used through aport on only the right side of the patient. However, the ablation device100 can also be used through a right thoracotomy.

FIGS. 2A-2F illustrate an ablation device 100 including a hinge 10, acam assembly 12, a lower jaw 14, one or more riders 16, a cam surface18, a floating jaw 20, a moving arm 24, one or more fingers 26, achannel 28, and a swivel attachment 30. The moving arm 24 can be coupledto the floating jaw 20 by the swivel attachment 30. The hinge 10 caninclude the cam assembly 12 that can be coupled to the lower jaw 14. Thecam assembly 12 can include the riders 16 and the fingers 26. The lowerjaw 14 can be fixed with respect to the hinge 10 and can include thechannel 28. The moving arm 24 can include the cam surface 18. The riders16 can engage the cam surface 18 on the moving arm 24. The fingers 26can bear against the floating jaw 20 to hold the floating jaw 20 inrelation to the moving arm 24 and the lower jaw 14. As an angle betweenthe floating jaw 20 and the lower jaw 14 reaches a predefined acuteangle, the fingers 26 on the cam assembly 12 can recess into the channel28 of the lower jaw 14 and can disengage from the floating jaw 20,allowing the floating jaw 20 to pivot about the swivel attachment 30.

FIG. 2A illustrates the ablation device 100 with the lower jaw 14substantially in contact with the floating jaw 20. In the position shownin FIG. 2A, the ablation device 100 can be inserted into the patient'sbody through a port or a thoracotomy. FIG. 2B illustrates the hinge 10in a substantially closed position. FIG. 2C is an exploded view of thehinge 10 in the substantially closed position. The fingers 26 of the camassembly 12 can bear against the floating jaw 20 to hold it in relationto the moving arm 24. As the predefined acute angle between the floatingjaw 20 and the lower jaw 14 is reached, the fingers 26 of the camassembly 12 can engage the channel 28 on the lower jaw 14. The fingers26 can then disengage from the floating jaw 20 in order to allow thefloating jaw 20 to pivot about the swivel attachment 30.

As shown in FIG. 2C, the hinge 10 can include an aperture 112 that canreceive a protrusion 114 of a neck 102. FIG. 2D illustrates the ablationdevice 100 including the neck 102, a collar 104, a hinge assembly 106, athumb ring 108, and a trigger 110. In some embodiments, the ablationdevice 100 can be rotated about the hinge assembly 106. In someembodiments, the surgeon can place his or her thumb through the thumbring 108 and his or her fingers through the trigger 110. The trigger 110can be coupled via a wire or a cable (not shown) to the floating jaw 20and the moving arm 24 in order to control the movement of the floatingarm 20 and/or the moving arm 24. FIG. 2E illustrates the ablation device100 in a substantially open position. FIG. 2F illustrates the ablationdevice 100 in a partially-open position.

FIGS. 3A-3E illustrate all embodiment of an ablation device 100including an upper jaw 200 and a lower jaw 202. As shown in FIGS. 3A and3B, the upper jaw 200 can be positioned in a parallel relationship tothe law jaw 202 about an axis 204. The upper jaw 200 can be positioned adistance d₁ from the lower jaw 202, with the distance d₁ being within arange of approximately 12 mm to approximately 15 mm. The outer portionsof the upper jaw 200 and the lower jaw 202 can be separated by adistance d₂. FIG. 3B illustrates an embodiment of the ablation device100 including the upper jaw 200 and the lower jaw 202 coupled to acentral support 206. The upper jaw 200 can be coupled to the centralsupport 206 with an upper four-bar linkage 208. The lower jaw 202 can becoupled to the central support 206 with a lower four-bar linkage 210.

FIG. 3C illustrates forces on a four-bar linkage 208 or 210, with thegrounded portion indicating the position of the central support 206.FIG. 3D illustrates a distance d₃ between the central support 206 andthe upper jaw 200 and the lower jaw 202. The distance d₃ can represent adistance occupied by the upper four-bar linkage 208 and/or the lowerfour-bar linkage 210. FIG. 3E illustrates the upper jaw 200 coupled toan upper four-bar linkage 208 that can be biased with a spring 212 andcan include an aperture 214. The aperture 214 can receive a first pin216. The four-bar linkage 208 can pivot about a pivot point 218. Asecond pin 220 can be coupled between the upper jaw 200 and the upperfour-bar linkage 208. The spring 212 can include a coil spring, atorsional spring, a beam spring, or any other suitable biasing member.The spring 212 can bias the upper jaw 200 to a near parallel positionwith the lower jaw 202 when the jaws are in their open position. Due tothe configuration of the aperture 214, the upper jaw 200 can begin aclamping action at its distal end and can finish the clamping action atits proximal end. The upper four-bar linkage 208 can be designed inorder to limit rotation in a downward direction. In some embodiments,the upper jaw 200 can be a moveable jaw, while the lower jaw 202 can befixed. In other embodiments, both the upper jaw 200 and the lower jaw202 can move.

FIGS. 4A-4E illustrate another embodiment of the ablation device 100including a movable upper jaw 200 and a movable lower jaw 202. In oneembodiment, the upper jaw 200 and/or the lower jaw 202 can beconstructed of a substantially malleable material. The upper jaw 200 canbe connected to a central support 206 by an upper four-bar linkage 208.The upper four-bar linkage 208 can include a first aperture 214, whichcan receive a first pin 216. The upper four-bar linkage 208 can also becoupled to the upper jaw 200 with a second pin 220. The upper four-barlinkage 208 can be coupled to the central support 206 and can pivotabout a first pivot 218. The lower jaw 202 can be coupled to the centralsupport 206 with a lower four-bar linkage 210. The lower four-barlinkage can include a second aperture 222 that can receive a third pin224. The lower four-bar linkage 210 can also be coupled to the lower jaw202 with a fourth pin 226. The lower four-bar linkage 210 can pivot withrespect to the central support 206 via a second pivot 228. The ablationdevice 100 can also include a cable or wire 230 which can be positionedaround the first pivot 218 and the second pivot 228 and can continuethrough the central support 206. Proximal ends of the wire or cable 230can be connected to an actuator device (not shown).

FIG. 4B illustrates the upper jaw 200 in its open position and the lowerjaw 202 in its closed position. First pin 216 can be located in an upperportion of the first aperture 214 when the upper jaw 200 is in its openposition. The first pin 216 can be biased into the upper portion of thefirst aperture 214 by a spring or other biasing member, which can make adistal end 232 of the upper jaw 200 come into contact with the targettissue first. The third pin 224 is shown in FIG. 4B in an upper positionwithin the second aperture 222 when the lower jaw 202 is in its closedposition. In this manner, the upper jaw 200 and the lower jaw 202 can beconstrained by the movement of the first pin 216 within the firstaperture 214 and the third pin 224 within the second aperture 222. Thefirst aperture 214 and the second aperture 222 can be designed toprovide any desirable gap between the upper jaw 200 and the lower jaw202. The first aperture 214 and the second aperture 222 can be designedin order to provide a distance d between the second pin 220 and thefourth pin 226 when the upper jaw 200 is in its open position and thelower jaw 202 is in its closed position. This distance d can represent aforward travel of the upper and lower jaws in their closed positions.The cable or wire 230 can provide a means to index the upper jaw 200 andlower jaw 202 relative to a handle (not shown) coupled to the centralsupport 206.

FIG. 4C is a line diagram of the ablation apparatus 100, while FIG. 4Dis a solid model diagram of the ablation device 100. FIG. 4D illustratesthat the upper four-bar linkage 208 and the lower four-bar linkage 210can each include two links. For example, the upper four-bar linkage 208can include a first link 234 and a second link 236, and the lowerfour-bar linkage 210 can include a third link 238 and a fourth link 240.The four-bar linkages 208 and 210 with multiple links can also includethe appropriate number of apertures and pins in order to couple thefour-bar linkages to the central support 206 and the upper jaw 200 andthe lower jaw 202. However, some embodiments of the ablation device 100can include only a single link for the upper four-bar linkage 208 and/oronly a single link for the lower four-bar linkage 210. FIG. 4E isanother solid model diagram of the ablation device 100. FIG. 4E alsoillustrates the upper four-bar linkage 208 including two links and thelower four-bar linkage 210 including two links.

FIGS. 5A through 5D illustrate an embodiment of the ablation device 100including an upper four-bar linkage 208 and a lower four-bar linkage 210with stop members 248 and 250 positioned within recesses 252 and 254.The upper stop member 248 can be included within the upper four-barlinkage 208, and the upper recess 252 can be included in the upper jaw200. The lower stop member 250 can be included in the lower four-barlinkage 210, and the lower recess 254 can be included in the lower jaw202. The configurations of the upper four-bar linkage 208 and the lowerfour-bar linkage 210 along with the upper and lower stop members 248 and250 can allow the ablation device 100 to be in a closed position havinga smaller distance d₁ between the upper jaw 200 and the lower jaw 202.The smaller distance d₁ between the upper jaw 200 and the lower jaw 202can allow the ablation device 100 to be inserted into a smaller port inthe patient's side.

FIG. 5B illustrates the upper jaw 200 and the lower jaw 202 in theiropen positions with a distance d₂ between the upper jaw 200 and thelower jaw 202. The distance d₁ shown in FIG. 5A can be approximately 2mm, in some embodiments. The distance d₂ shown in FIG. 5B can beapproximately 15 mm, in some embodiments. FIGS. 5C and 5D are solidmodel diagrams of the ablation apparatus 100. FIGS. 5C and 5D illustratethat the upper four-bar linkage 208 and the lower four-bar linkage 210can each be constructed of two links. For example, the upper four-barlinkage 208 can include a first link 234 and a second link 236, and thelower four-bar linkage 210 can include a third link 238 and a fourthlink 240. As shown in FIG. 5C, the stop members 248 and 250 can be pinsthat can join the two links of the four-bar linkages. For example, thestop member 250 can join the third link 238 to the fourth link 240 ofthe lower four-bar linkage 210.

FIGS. 6A and 6B illustrate an embodiment of the wire or cable 230wrapped around portions of the upper four-bar linkage 208 and the lowerfour-bar linkage 210. FIG. 6A also illustrates the use of a first spring242 and a second spring 244 in order to bias the upper jaw 200 and thelower jaw 202. In some embodiments, the first spring 242 and the secondspring 244 can bias the upper jaw 200 and the lower jaw 202 into theiropen positions so that the first pin 216 is in an uppermost positionwithin the first aperture 214 and the third pin 224 is in a lowermostportion within the second aperture 222. FIG. 6A also illustrates aflexible spacer 246 that can be positioned between the upper jaw 200 andthe lower jaw 202 in order to prevent tissue from being caught withinthe moving parts of the upper four-bar linkage 208 and the lowerfour-bar linkage 210. In some embodiments, the cable 230 can be splitnear a clevis in order to run the cable 230 on both sides of the upperjaw 200 and the lower jaw 202, for example, in order to run the cable230 from top to bottom or from bottom to top. In some embodiments, theupper jaw 200 and the lower jaw 202 can be placed at an offset position(e.g., side-by-side) in order to reduce an overall height whenintroducing the ablation device 100 into the patients body.

FIGS. 7A-7I illustrate alternative embodiments of the ablation device100. FIG. 7A illustrates an ablation device 100 including an upper jaw200, a lower jaw 202, an upper four-bar linkage 208, a lower four-barlinkage 210, and a cable 230 coupled between the upper and lowerfour-bar linkages 208, 210. The cable 230 can be wrapped around a firstpivot 218 and then connected to the lower four-bar linkage 210, and thenthe same cable 230 can be wrapped around a second pivot 228 andconnected to the upper four-bar linkage 218. In this manner, the cable230 can form a cross-over cable system. Decreasing an angle of thecross-over cable system can increase the closing force between the upperjaw 200 and the lower jaw 202. FIG. 7B illustrates one embodiment of thecable 230 in a cross-over cable configuration.

FIG. 7C illustrates one embodiment of the cable 230 in a triangularconfiguration. A force exerted on the cable 230 can generate a force inalong the X axis F, and a force along the Y axis F_(y). FIG. 7Dillustrates another configuration for the cable 230. The cable 230 canwrap around any suitable pivots or pins, such as the first pivot 218 andthe second pivot 228. FIG. 7E illustrates another embodiment of across-over cable system. FIG. 7F illustrates the forces and thepositions at which the cable 230 can be grounded in one embodiment of acable system. FIGS. 7G and 7H schematically illustrate the cable 230connected to a link of the upper four-bar linkage 208 and a link of thelower four-bar linkage 210. A higher force can be exerted by the linksas shown in FIG. 7G, and a lower force can be exerted by the links asshown in FIG. 7H. FIG. 7I illustrates that, in some embodiments, theupper jaw 200 and/or the lower jaw 202 can be allowed to rotate plus orminus 30 degrees without binding the cable 230 or the cross-over cablesystem. In other embodiments, the cable 230 and/or a cable system caninclude other members, such as a toggle, a cam, or a pulley system.

FIGS. 8A-8E illustrate an embodiment of the ablation apparatus 100including a gear 256, a stop member 258, and a socket 260. The gear 256can include teeth that can cooperate with corresponding recesses on thesocket 260 in order to perform an indexing feature for the upper jaw 200and the lower jaw 202. The stop member 258 can prevent the gear 256 fromtraveling beyond a predetermined position. The upper jaw 200 and/or thelower jaw 202 can be spring loaded into an open position. Distal ends232 of the upper jaw 200 and the lower jaw 202 can contact one anotherfirst once the spring bias has been overcome. The upper jaw 200 and thelower jaw 202 can clamp into contact progressively from the distal end232 to their proximal ends 262.

FIG. 8B illustrates that the gear 256 and the socket 260 can have aratchet and detent configuration in order to set an angle between theupper jaw 200 and the lower jaw 202 relative to the central port 206.The angle can be plus or minus 30 degrees, in some embodiments. FIG. 8Cillustrates one embodiment of a U-shaped spring 264 that can be coupledbetween the upper jaw 200 and the lower jaw 202. FIG. 8D illustrates anembodiment of a torsional spring 266 that can be coupled to a ground,which can represent the central support 206 and one or more pivot pointson the upper jaw 200. FIG. 8E illustrates another embodiment of thetorsional spring 266 that can be coupled to the upper jaw 200 aroundvarious pins.

FIG. 9 illustrates an ablation tool 310 according to one embodiment ofthe invention. The ablation tool 310 can be used in conjunction withfirst and second catheters in an ablation system, as shown and describedwith respect to FIGS. 11 and 12. In some embodiments of the invention,the ablation tool 310 can be a bipolar bilateral ablation tool. Theablation tool 310 can include a handle 312, jaws 314, and a hingedconnection 316. The handle 312 can be used by a surgeon to orient andclose the jaws 314. The handle 312 can include a first circular portion352 that can receive a surgeon's thumb and a second circular portion 354that can receive one or more of a surgeon's fingers. The handle 312 canalso include a hinge 356 coupled to a collar 358. The ablation tool 310can include an elongated neck 360. The collar 358 of the handle 312 canbe coupled to the elongated neck 360. The elongated neck 360 can have alength sufficient to reach target tissue 315 within a patient's heartfrom an incision 342 (as shown in FIGS. 11 and 12).

The jaws 314 can include an upper jaw 318 and a lower jaw 320. The upperjaw 318 and the lower jaw 320 can be coupled to the hinged connection316. The upper jaw 318 can include a first cannula connection 322, abody portion 328, lateral supports 362, and a central support 364. Thelateral supports 362 can be movably coupled to the hinged connection316. The central support 364 can be movably coupled to the lateralsupports 362. The central support 364 can be rigidly coupled or integralwith the body 328. The first cannula connection 322 can include a nipple326 and can be rigidly coupled or integral with the central support 364.As shown in FIG. 10, the nipple 326 of the first cannula connection 322can extend axially from and be aligned with the body portion 328 of theupper jaw 318. The upper jaw 318 can also include one or more upperelectrodes (not shown). The one or more upper electrodes can be coupledto one or more of the body 328, the lateral supports 362, and thecentral support 364.

The lower jaw 320 can include a second cannula connection 324 and a bodyportion 368. The second cannula connection 324 can include a nipple 330on a distal end 332 of the lower jaw 320. The nipple 330 can be alignedaxially with the body portion 368 of the lower jaw 320. The lower jaw320 can also include one or more electrodes 370 coupled to the bodyportion 368.

The first cannula connection 322 and the second cannula connection 324can include any suitable connector or fastener that can mate with anysuitable connector or fastener on the first and second catheters 344,346. For example, the first and second cannula connections 322, 324 caninclude any suitable type of male protrusions or female recesses thatcan mate with corresponding female recesses and male protrusions,respectively, on the first and second catheters 344, 346. For example,press-fit connections, threaded connections, clasps, pins, clamps,sheaths, collars, or any combination thereof, can be used to connect thejaws 314 to the first and second catheters 344, 346.

In some embodiments, the first cannula connection 322 and the secondcannula connection 324 can be combined in a single nipple (not shown)that can be bifurcated across both the upper jaw 318 and the lower jaw320.

In some embodiments, the ablation tool 310 can include one or moreelectrodes on the upper jaw 318 and one or more electrodes 370 on thelower jaw 320 for a bipolar bilateral ablation device. The ablation tool310 can use the hinged connection 316 to balance contact across thetarget tissue 315 between the jaws 314. In other embodiments, theablation tool can include one or more electrodes on only the upper jaw318 or the lower jaw 320 for a monopolar unilateral ablation device.

FIG. 11 illustrates the nipple 326 of the upper jaw 318 coupled to afirst catheter 344 and the nipple 330 of the lower jaw 320 coupled to asecond catheter 346. The first catheter 344 can be fed through a cavity340 of the patient and out the incision 342 (e.g., in the patient'sside). The first catheter 344 can be positioned along a first path inorder to bring the upper jaw 18 into engagement with the target tissue315. The second catheter 346 can be fed along a second path on anopposite side of the target tissue 315. The second catheter 346 can bepositioned along the second path in order to bring the lower jaw 320into engagement with the target tissue 315.

According to one method of the invention, as shown in FIGS. 11 and 12,the first catheter 344 and the second catheter 346 can be directedthrough the incision 342 into a patient's cavity until their centralportions are adjacent the target tissue 315. The distal portions of thefirst catheter 344 and the second catheter 346 can then be directedonward and out of the patient's body cavity. The first catheter 344 caninclude a first proximal end 348 and the second catheter 346 can includea second proximal end 350. The first and second proximal ends 348, 350can be in position to extend from the incision 342 before the ablationtool 310 is coupled to the first and second catheters 344, 346. Thefirst and second proximal ends 348, 350 can be connected to the upperand lower jaws 318, 320 of the ablation tool 310. The first and secondcatheters 344, 346 can be pulled back into and through the patient'scavity in order to pull the ablation device 310 into the patient'scavity. The first and second catheters 344, 346 protect the patient'stissue during the insertion of the ablation tool 310 into the patient'scavity and provide a predefined path for the insertion. Morespecifically, the first and second catheters 344, 346 can protect thepatient's tissue from being poked or dissected by the jaws 314 of theablation tool 310 during insertion of the ablation tool 310 into thepatient's cavity. The first and second catheters 344, 346 can also guidethe jaws 314 of the ablation tool 310 until the jaws 314 are adjacentthe target tissue 315. Ablation energy (e.g., radio frequency energy,thermal energy, cryogenic energy, microwave energy, etc.) can beprovided to the one or more electrodes 370 coupled to the upper jaw 318and/or the lower jaw 320.

After a first ablation is complete, the ablation tool 310 can beretracted from a first side of the patient's heart and then insertedalong the opposite ends of the first and second catheters 344, 346 inorder to ablate a second side of the patient's heart along the pulmonaryveins or other target tissue 315.

FIGS. 13 and 14 illustrate multiple ablations and approaches that can beachieved using one or more ablation tools 310. As shown in FIGS. 13 and14, one ablation tool 310 can be positioned to ablate tissue adjacentthe right pulmonary veins, and another ablation tool 310 can bepositioned to ablate tissue adjacent the left pulmonary veins. As shownin FIG. 13, the neck 360 of the ablation tool 310 can be positionedthrough a sixth intercostal incision and can be positioned atapproximately a right angle with respect to the jaws 314. As shown inFIG. 14, the neck 360 of the ablation tool 310 can be positioned througha third intercostal incision and can be positioned along substantiallythe same axis as the jaws 314.

Various additional features and advantages of the invention are setforth in the following claims.

1. An ablation device for ablating target tissue adjacent pulmonaryveins of a patient, the ablation device comprising: a central support;an upper four-bar linkage coupled to the central support; an upper jawcoupled to the upper linkage, the upper jaw including an upper electrodereceiving ablation energy; a lower four-bar linkage coupled to thecentral support; and a lower jaw coupled to the lower linkage, the lowerjaw including a lower electrode receiving ablation energy.
 2. Theablation device of claim 1 wherein the ablation energy includes at leastone of radio frequency energy, thermal energy, cryogenic energy, andmicrowave energy.
 3. The ablation device of claim 1 wherein the upperfour-bar linkage includes a first link and a second link and the lowerfour-bar linkage includes a third link and a fourth link.
 4. Theablation device of claim 1 wherein at least one of the upper four-barlinkage and the lower four-bar linkage includes an aperture thatreceives a pin.
 5. The ablation device of claim 1 and further comprisinga cable coupled to the upper four-bar linkage and the lower four-barlinkage, the cable being movable in order to position the upper jaw andthe lower jaw.
 6. The ablation device of claim 1 wherein the upperfour-bar linkage is coupled to the central support by a first pivot andthe lower four-bar linkage is coupled to the central support by a secondpivot.
 7. The ablation device of claim 1 wherein at least one of theupper jaw and the second jaw rotates about at least one pin according toa distance defined by an aperture.
 8. The ablation device of claim 1wherein at least one of the upper four-bar linkage and the lowerfour-bar linkage includes a stop member and at least one of the upperjaw and the lower jaw includes a first recess that receives the stopmember.
 9. The ablation device of claim 1 and further comprising a cableassembly that wraps around a first portion of the upper four-bar linkageand a second portion of the lower four-bar linkage.
 10. The ablationdevice of claim 1 and further comprising at least one spring coupledbetween the central support and at least one of the upper four-barlinkage and the lower four-bar linkage.
 11. The ablation device of claim1 and further comprising a flexible spacer coupled to the upper jaw andthe lower jaw to prevent tissue from contacting the upper four-barlinkage and the lower four-bar linkage.
 12. The ablation device of claim1 wherein at least one of the upper jaw and the lower jaw can rotateapproximately 30 degrees without binding a cable control assembly. 13.The ablation device of claim 1 and further comprising a gear coupled tothe upper four-bar linkage and the lower four-bar linkage; and a socketcoupled to the central support, the socket receiving the gear.
 14. Amethod of ablating target tissue adjacent pulmonary veins of a patient,the method comprising: providing an ablation device with at least onefloating jaw including at least one electrode; locking the at least onefloating jaw; inserting the at least one floating jaw into a side of thepatient; approaching the pulmonary veins substantially directly from theside of the patient with the at least one floating jaw; unlocking the atleast one floating jaw; articulating the at least one floating jaw withrespect to a central support to accommodate target tissue adjacent thepulmonary veins; and providing ablation energy to the at least oneelectrode.
 15. The method of claim 14 and further comprising allowingthe floating jaw to float with respect to pivot points.
 16. The methodof claim 14 and further comprising biasing the floating jaw with respectto the central support.
 17. The method of claim 14 and furthercomprising providing two floating jaws.
 18. The method of claim 14 andfurther comprising providing at fixed jaw.
 19. The method of claim 14and further comprising providing ablation energy including at least oneof radio frequency energy, thermal energy, cryogenic energy, andmicrowave energy.
 20. A method of ablating target tissue adjacentpulmonary veins of a patient through an incision in the patient, themethod comprising: inserting a first catheter through the incision andpositioning the first catheter on a first side of the pulmonary veins;inserting a second catheter through the incision and positioning thesecond catheter on a second side of the pulmonary veins; coupling anupper jaw of an ablation tool to the first catheter; coupling a lowerjaw of the ablation tool to the second catheter; moving the upper jawadjacent the pulmonary veins with the first catheter; moving the lowerjaw adjacent the pulmonary veins with the second catheter; and providingablation energy to at least one electrode coupled to at least one of theupper jaw and the lower jaw.
 21. The method of claim 20 and furthercomprising connecting a nipple of at least one of the upper jaw and thelower jaw to at least one of the first catheter and the second catheter.22. The method of claim 20 and further comprising providing ablationenergy including at least one of radio frequency energy, thermal energy,microwave energy, and cryogenic energy.
 23. The method of claim 20 andfurther comprising performing bipolar ablation.
 24. The method of claim20 and further comprising moving a body of the upper jaw with respect toat least one of lateral supports and a central support of the upper jaw.25. The method of claim 20 and further comprising moving at least one ofthe upper jaw and the lower jaw within at least one plane with respectto a hinge connection of the ablation tool.
 26. The method of claim 20and further comprising inserting the first catheter and the secondcatheter through at least one of a third intercostal incision and asixth intercostal incision.